title: Development of a strategic process using checklists to facilitate team preparation and improve communication during neonatal resuscitation.
abstract: BACKGROUND
  To improve our neonatal resuscitations we review video recordings of actual high-risk deliveries as an ongoing quality review process. In order to help identify and review errors that occurred during resuscitation we educated our resuscitation teams using crew resource management and in March 2009 developed a checklist to be used for potentially high-risk resuscitations.
  
  
  OBJECTIVE
  To describe our experience using checklists as an essential component of the actual resuscitation of potentially high-risk infants.
  
  
  METHODS
  The checklist includes pre- and debrief components, along with duty-specific sub-lists (MD, RT, RN). The debrief is conducted upon completion of the resuscitation and addresses what was done well, what was not done well, and how it could have been improved. We reviewed all available checklists from March 2009 to November 2011 (n=260). We then performed a second review to determine if experience has changed the leaders perception of how resuscitation was being performed from November 2011 to May 2012 (n=185).
  
  
  RESULTS
  We reviewed 445 completed checklists with quality assurance video review. During the initial cohort the most commonly described problems were: communication (n=58), equipment preparation and use (n=56), inappropriate decisions (n=87), leadership (n=56), and procedures (n=25). The number of debriefs where communication was identified as a problem decreased from 23% in the first time period to 4% (p<0.001) in the latter.
  
  
  CONCLUSIONS
  The use of checklists during neonatal resuscitation was helpful in improving overall communication, and allowed for rapid identification of issues that need to be addressed by institutional leaders. There needs to be further evaluation of the utility and benefit of checklists for neonatal resuscitation. Based on our past and present experience we encourage the use of checklists for neonatal resuscitation teams.
authors.affiliation: Division of Neonatology, UCSD Medical Center, University of California, San Diego, CA, USA. Electronic address: akatheria@ucsd.edu.
authors.forename: Anup
authors.initials: A
authors.lastname: Katheria
authors.forename: Wade
authors.initials: W
authors.lastname: Rich
authors.forename: Neil
authors.initials: N
authors.lastname: Finer
mesh_terms: D057189:Checklist; D003142:Communication; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D019300:Medical Errors / Q000517:prevention & control; D010348:Patient Care Team / Q000458:organization & administration*; D012151:Resuscitation / Q000592:standards*; D014741:Video Recording
keywords: Checklist; DR; Debrief; GA; NRP; Neonatal; PO; Resuscitation; VLBW; delivery room; gestational age; neonatal resuscitation practice; pulse oximeter; very low birth weight